Fish oil and African Americans
A lot of people take fish oil capsules every day. Where did that come from, and why is it important?
People who eat more fish have lower rates of heart disease, the number one killer of African Americans. Fish oil is rich in omega-3 fatty acids, which lower triglycerides, modestly lower blood pressure, and reduce inflammation, all of which help slow plaque buildup in the arteries. Plaque narrows the vessels and can block them completely. A clogged artery in the heart is a heart attack, a clogged artery in the brain is a stroke, and clogged arteries in the legs cause peripheral artery disease. For the men out there, clogged arteries in the penis cause erection problems.
African Americans have the highest incidence of high blood pressure, heart disease (clogged arteries), heart failure, and sudden cardiac death. So this is important!
What’s in fish oil?
Fish oil is the richest source of two omega-3 fatty acids, EPA and DHA. These are the forms the heart and brain use. Plant foods such as flaxseed, chia, and walnuts contain a different omega-3 (ALA), and the body converts only a small fraction of it into EPA and DHA, in everyone. That is why oily fish, fish oil, or algae-based omega-3 supplements (which contain DHA directly) are better sources than plant oils.
It’s not just how much fish we eat, it’s how we cook it
Traditional Southern cooking tends to be higher in saturated fat and lower in omega-3-rich foods. Putting salted pork in our vegetables and boiling the healthiness out of them is a practice that needs to be abandoned.
Fried fish is a bigger problem. In the REGARDS study of more than 21,000 adults, Black participants ate about twice as much fried fish as White participants (0.96 vs. 0.47 servings a week), and frying is linked to higher heart disease risk (Public Health Nutrition). Cost and access matter too: fresh fish is expensive, and many Black neighborhoods are food deserts with limited access to it.
The precision medicine connection
Precision medicine asks whether a treatment works differently for you. For African Americans and fish oil, the answer appears to be yes.
1. Fish oil may protect Black adults more
In the VITAL trial of nearly 26,000 adults, 1 gram of fish oil a day lowered heart attacks by 28% overall, by 40% in people who ate little fish, and by 77% in African American participants (Harvard Medical School). Subgroup results like this need confirmation, but no other group in the trial showed a larger benefit.
2. Our genes make the type of fat we eat matter more
People of African ancestry are far more likely to carry variants in the FADS genes that efficiently convert dietary fats into long-chain forms (BMC Genetics, 2011). On a modern diet heavy in omega-6 vegetable oils from fried and processed foods, that efficiency produces more arachidonic acid, a building block of inflammation. Getting EPA and DHA directly from fish, while cutting back on fried foods and seed oils, helps shift that balance. A 2023 University of Virginia study found new genetic sources of variation in omega-3 levels in African Americans, more proof that research needs diverse participants.
3. Know when to be careful
Fish oil supplements slightly raise the risk of atrial fibrillation (an irregular heartbeat), especially at doses above 1 gram a day, and can add to bleeding risk with blood thinners. If you have high triglycerides and already take a statin, ask about prescription icosapent ethyl, a purified EPA that lowered heart attacks and strokes in the REDUCE-IT trial.
These are the kinds of differences covered in Better Black Health, written for patients and families, and Precision Medicine for African Americans (Springer Nature), written for clinicians.
May help prevent cancer too
Observational studies link eating oily fish to a lower risk of some cancers. A major study found that eating fish one to five times a week was associated with a lower risk of breast cancer, and another large study found that “fish-eaters” had a lower risk of cancer overall than “meat-eaters.” In VITAL, however, fish oil capsules did not lower cancer rates, so the cancer benefit seems to come from eating fish, not from supplements.
Eat more fish, and cook it right
Aim for two servings a week of oily fish such as salmon, mackerel, sardines, trout, or herring, baked, broiled, or grilled rather than fried. Grilled salmon salads, baked whiting, and mackerel patties are easy places to start. If you don’t eat fish regularly, a high-quality fish oil supplement can help fill the gap. Ask your doctor what dose is right for you.
ASK YOUR DOCTOR ABOUT A DAILY FISH OIL SUPPLEMENT
